Heterosexual couple we are, in love big time, to be married soon. Massive passion, tremendous sweet love and sex. Question is: in the heat of passion I have had him come inside my vagina (once) also have swallowed sperm twice. I need to know exactly how much of a risk there is in acquiring his strain assuming we have different stains of the hiv virus. In the heat of passion people do things they ordinarily would not dream of doing. This love is so high there is no drug in the world that can compare! I am worried about my actions of late. If I never allow this to happen again is it still too late? Because if it's too late, I may as well enjoy the sex and keep on going all the way if you know what I mean! Thanks in advance for your response. p.s. you may edit this for publication if you wish.

Response from Dr. Sherer

For years, clinicians advised people with HIV who choose to have sex to be safe, out of concern that mixing different strains of HIV could have deleterious effects; in addition, there is the risk of the transmission of other sexually transmissable infections, such as hepatitis B, syphilis, and other STIs.

There is now some evidence that supports this view. In several studies presented at the Retrovirus Conference last February, individuals were observed who were clinically and virologically stable who had sudden deteriorations in their status which was associated with the appearance of a new strain or strains of HIV.
In particular, new clones of HIV with new resistance mutations which limit the effectiveness of their current HIV medications have been observed.

So I am compelled to repreat the recommendation that your safest practice with your partner is to use latex and remain safe.

I would also encourage you to ask the same question to your personal physician, as the details of your medical history would add important information to the discussion. If both of you were ART naive, i.e. had never taken HIV medications, less concern might be attached to the possible impact of unprotected sex on the effectiveness of ART.
Or if both of you were successfully controlled virologically on the same ART regimen, with viral loads below detection, the risk of transmission would be substantially reduced, though not to zero. And if you both had evidence of no other STIs, hepatitis, etc, concern for other transmitted STIs would be lessened, though again, not to zero, as it is not possible to prove that you both are free from an STI.

As this is a personal decision, at a minimum I would suggest that you gather all of the information you can in order to make the decision. As a matter of preparing for either decision, I also suggest that you try intimacy with safety, i.e. latex and safer sexual activity, in order to expand your view of safe sex. Safe sex has a variable reputation, but pleny of patients tell me that they and their partner are fulfilled, sexy, and satisfied with a wide variety of sexual activity while being safe. Your mental attitude towards it can make a big difference; with a love as big as you describe, there may be more room than you might think for experimenting with safe sex, and even settling on it.

I recommend that you explore The Body's website for stories of happy safe sex, and alternatives that you might explore.

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